The athlete is on the ground, the venue has no imaging, and the next decision — immobilize or reduce, clear or pull — will determine whether this injury ends the game or ends the career. Apply the wrong threshold and the consequences are not documentation errors: a mechanically unstable ankle cleared as functional, a tension-side femoral neck fracture missed on a normal radiograph, a concussion returned to contact because the symptoms resolved at the sideline. This handbook delivers the anatomically grounded, evidence-stratified decision framework that converts clinical uncertainty into reproducible, defensible management — sideline, training room, or operative suite. • Return-to-Play Decision System — 78 worked scenarios show exactly when to clear, hold, operate, or escalate, with the specific diagnostic lock that confirms each pathway • The threshold numbers that change the plan — glenoid bone loss percentages, retraction measurements, diastasis criteria, and stress examination values that separate nonoperative from operative care • Skeletal maturity as a mandatory variable — physeal fracture recognition, physis-sparing ACL technique selection, and OCD healing potential stratified by open versus closed physes • High-risk vs. low-risk stress fracture stratification — tension-side mechanics, watershed vascularity, and imaging-confirmed healing criteria by site • RED-S beyond the triad — energy availability calculation, HPG axis suppression mechanism, and why oral contraceptive withdrawal bleeds do not count toward clearance • Emergency action plan execution — log roll sequencing, helmet-removal decision, lucid interval recognition, and the AED location confirmation that happens before the first whistle Written for orthopaedic surgery residents, sports medicine fellows and physicians, athletic trainers, team physicians, and advanced practice providers managing injuries across competitive, recreational, and youth sport. Add this handbook to your coverage bag — and make every return-to-sport decision with the threshold clarity your athletes deserve.
